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Task-related oxygen uptake during domestic activities of daily life in patients with COPD and healthy elderly subjects.

Background Patients with COPD generally have a poor peak aerobic capacity and may therefore experience more inconvenience during domestic activities of daily life (ADLs). Yet, task-related oxygen uptake and symptom perception during ADLs have been studied rarely in COPD. It therefore remains unknown whether and to what extent differences may exist in task-related oxygen uptake and symptom perception during ADLs in COPD patients after stratification for gender, GOLD stage, MRC dyspnea grade or score on BODE index.

Methods Ninety-seven COPD patients and 20 healthy subjects performed 5 self-paced domestic ADLs with 4-min rest intervals: putting on socks, shoes and vest; folding 8 towels; putting away groceries; washing up 4 dishes, cups and saucers; and sweeping the floor for 4 min. Task-related oxygen uptake was assessed using a mobile oxycon, while Borg scores were used to assess task-related dyspnea and fatigue.

Results COPD patients used a significantly higher proportion of their peak aerobic capacity and ventilation to perform ADLs compared to healthy elderly subjects, accompanied by higher task-related Borg dyspnea scores. Patients with GOLD stage IV, MRC dyspnea grade 5 or BODE score of ≥6 points had the highest task-related oxygen uptake and dyspnea perception during the performance of domestic ADLs. Results showed no gender-related differences.

Conclusion COPD patients experience a relatively high metabolic load and symptom perception during the performance of ADLs that is not the same as seen in their healthy peers, particularly in patients with GOLD stage IV, MRC dyspnea grade 5 or BODE score of ≥6 points.

Grading the Severity of Obstruction in Mixed Obstructive-Restrictive Lung Disease.

BACKGROUND: The severity of obstructive pulmonary disease is determined by the percent predicted FEV(1) based on ATS/ERS guidelines. In patients with coexisting restrictive lung disease, the decrease in FEV(1) can overestimate the degree of obstruction. We hypothesize that adjusting the FEV(1) for the decrease in TLC results in a more appropriate grading of the severity of obstruction.

METHODS: We examined a large PFT database and identified patients with both restrictive (TLC < 80% predicted) and obstructive (FEV(1)/FVC < the lower limit of normal) lung disease. FEV(1) percent predicted was adjusted for the degree of restriction by dividing it by percent predicted TLC. We compared the distribution of severity grading between adjusted and unadjusted values according to ATS/ERS criteria, and determined how the distribution of severity would change based on asthma and COPD guidelines.

RESULTS: We identified 199 patients with coexisting restrictive and obstructive lung disease. By ATS/ERS grading, the unadjusted data categorized 76% of patients as having severe or very severe obstruction, and 11% as having mild or moderate obstruction. The adjusted data classified 33% with severe or very severe obstruction, and 44% with mild or moderate obstruction. Of the corrected values, 83% resulted in a change to less severe obstruction by ATS/ERS guidelines, and 44% and 70% of patients, respectively, would be reclassified as having less severe obstruction by current asthma and COPD guidelines.

CONCLUSIONS: This method results in a more appropriate distribution of severity of obstruction, which should lead to more accurate treatment of obstruction in these patients.

Clinical features and outcome of hospitalised adults and children with the 2009 influenza A H1N1 infection at Geneva's University Hospital.

To describe the clinical features and outcomes of hospitalised cases of the 2009 influenza A H1N1 virus infection at Geneva's University Hospital during the peak of the epidemic.

New driver mutations in non-small-cell lung cancer.

Treatment decisions for patients with lung cancer have historically been based on tumour histology. Some understanding of the molecular composition of tumours has led to the development of targeted agents, for which initial findings are promising. Clearer understanding of mutations in relevant genes and their effects on cancer cell proliferation and survival, is, therefore, of substantial interest.

We review current knowledge about molecular subsets in non-small-cell lung cancer that have been identified as potentially having clinical relevance to targeted therapies. Since mutations in EGFR and KRAS have been extensively reviewed elsewhere, here, we discuss subsets defined by so-called driver mutations in ALK, HER2 (also known as ERBB2), BRAF, PIK3CA, AKT1, MAP2K1, and MET. The adoption of treatment tailored according to the genetic make-up of individual tumours would involve a paradigm shift, but might lead to substantial therapeutic improvements.

Stereotactic radiotherapy of primary lung cancer and other targets: results of consultant meeting of the International Atomic Energy Agency.

To evaluate the current status of stereotactic body radiotherapy (SBRT) and identify both advantages and disadvantages of its use in developing countries, a meeting composed of consultants of the International Atomic Energy Agency was held in Vienna in November 2006. Owing to continuous developments in the field, the meeting was extended by subsequent discussions and correspondence (2007-2010), which led to the summary presented here.

The advantages and disadvantages of SBRT expected to be encountered in developing countries were identified. The definitions, typical treatment courses, and clinical results were presented. Thereafter, minimal methodology/technology requirements for SBRT were evaluated. Finally, characteristics of SBRT for developing countries were recommended. Patients for SBRT should be carefully selected, because single high-dose radiotherapy may cause serious complications in some serial organs at risk. Clinical experiences have been reported in some populations of lung cancer, lung oligometastases, liver cancer, pancreas cancer, and kidney cancer.

Despite the disadvantages expected to be experienced in developing countries, SBRT using fewer fractions may be useful in selected patients with various extracranial cancers with favorable outcome and low toxicity.

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